Claim for Injury Allowance and Notification of Work Injury (211)

The work-injury allowance claim form is intended for an employee and a self-employed person who have been injured at work as a result of a work-related accident. The form is also intended for a volunteer who was injured during his or her volunteer activities. In this form you can also submit a request for recognition of an occupational disease or medical disability resulting from working conditions.

Please note that in case of Novel Coronavirus contamination in the workplace:

The form must be completed as a "work-related accident" and not as an occupational disease, and a questionnaire on Novel Coronavirus contamination must be attached to the claim (Employer – BTL/257, Employee – BTL/258, Self-employed – BTL/259).